Traditionally, people used to live with their grown children or extended families when they grew old and became incapacitated. Now it’s far more common (at least here) for the elderly to live in nursing homes or assisted living units. There’s also the option of in-home hospice care, but I think what few would really want is where many end up in their final moments- holding on until the very end suffering from unpleasant procedures or unconscious, tethered in a hospital bed. This very thoughtful and sobering book looks at all those scenarios, describing the history of how nursing homes and assisted living became a thing, looking at how they’ve changed over the years, and examining whether those options really are in the best interest of the elderly people they serve. The doctor (I must read more by him!) also looks carefully at what people actually want as the end of their lives draws near- what’s most important to them, and how can it be achieved. It’s not always seeking every last treatment that has the smallest chance of a positive outcome. It’s usually the simple things that begin to matter most- being close to family and friends, maintaining some autonomy, feeling like their lives have had worth . . . There are a lot of poignant examples from people Dr. Gawande has known- his own acquaintances, patients, friends, and finally, in a very personal and moving account, his own father. It’s difficult to read at times and makes you think about the hard things that nobody really wants to discuss, but points out how important those discussions are before they become crucial. I’m very glad I read this
